Uncontrolled gout can cause significant joint and organ damage and has been associated with impairments in quality of life and high economic cost. Gout has also been associated with other comorbid diseases, such as chronic kidney disease. The current study explored if healthcare resource utilization (HRU) and survival differs between patients with incident gout in the presence or absence of chronic kidney disease (CKD). Clalit Health Services (CHS) data were used to conduct a retrospective population-based cohort study of incident gout between 1/1/2006–31/12/2009. Incident cases of gout were identified and stratified by CKD status and by age group (< 55 and 55+ years). CKD status was defined as a pre-existing diagnosis of chronic kidney disease, chronic renal failure, kidney transplantation, or dialysis at index date. Demographic and clinical characteristics, as well as healthcare resource use, were reported. A total of 12,940 incident adult gout patients, with (n = 8286) and without (n = 4654) CKD, were followed for 55,206 person-years. Higher rates of HRU were observed for gout patients with CKD than without. Total annual hospital admissions for patients with gout and CKD were at least 3 times higher for adults < 55 (mean = 0.51 vs 0.13) and approximately 1.5 times higher for adults 55+ (mean = 0.46 vs 0.29) without CKD. Healthcare utilization rates from year 1 to year 5 remained similar for gout patients < 55 years irrespective of CKD status, however varied according to healthcare utilization by CKD status for gout patients 55+ years. The 5-year all-cause mortality was higher among those with CKD compared to those without CKD for both age groups (HR< 55 years = 1.65; 95% CI 1.01–2.71; HR55+ years = 1.50; 95% CI 1.37–1.65). The current study suggests important differences exist in patient characteristics and outcomes among patients with gout and CKD. Healthcare utilization differed between sub-populations, age and comorbidities, over the study period and the 5-year mortality risk was higher for gout patients with CKD, regardless of age. Future work should explore factors associated with these outcomes and barriers to gout control in order to enhance patient management among this high-risk subgroup.

中文翻译：

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痛风和慢性肾脏病：医疗保健利用和生存

不受控制的痛风会导致严重的关节和器官损伤，并与生活质量受损和高经济成本有关。痛风还与其他合并症有关，例如慢性肾病。目前的研究探讨了在存在或不存在慢性肾脏疾病 (CKD) 的情况下，痛风患者之间的医疗资源利用率 (HRU) 和生存率是否不同。Clalit Health Services (CHS) 数据用于对 2006 年 1 月 1 日至 2009 年 12 月 31 日之间的痛风事件进行回顾性基于人群的队列研究。根据 CKD 状态和年龄组（< 55 岁和 55 岁以上）确定和分层痛风病例。CKD 状态被定义为在索引日期已存在慢性肾病、慢性肾功能衰竭、肾移植或透析的诊断。报告了人口统计学和临床​​特征，以及医疗资源使用情况。总共对 12,940 名成人痛风患者（n = 8286）和非（n = 4654）CKD 进行了随访 55,206 人年。观察到患有 CKD 的痛风患者的 HRU 发生率高于未患有 CKD 的痛风患者。55 岁以下的痛风和 CKD 患者的年总住院率至少高出 3 倍（平均值 = 0.51 对 0.13），而 55 岁以上的成人（平均值 = 0.46 对 0.29）则高出约 1.5 倍（平均值 = 0.46 对 0.29）。无论 CKD 状态如何，55 岁以下痛风患者的第 1 年至第 5 年的医疗保健利用率保持相似，但 55 岁以上痛风患者的 CKD 状态的医疗保健利用率会有所不同。在两个年龄组中，CKD 患者的 5 年全因死亡率高于非 CKD 患者（HR<55 岁 = 1.65；95% CI 1.01–2.71；HR55+ 岁 = 1.50；95% CI 1.37–1.65） . 目前的研究表明，痛风和 CKD 患者的患者特征和结局存在重要差异。在研究期间，亚人群、年龄和合并症之间的医疗保健利用率不同，无论年龄大小，患有 CKD 的痛风患者的 5 年死亡率风险更高。未来的工作应该探索与这些结果相关的因素和痛风控制的障碍，以加强这一高风险亚组的患者管理。目前的研究表明，痛风和 CKD 患者的患者特征和结局存在重要差异。在研究期间，亚人群、年龄和合并症之间的医疗保健利用率不同，无论年龄大小，患有 CKD 的痛风患者的 5 年死亡率风险更高。未来的工作应该探索与这些结果相关的因素和痛风控制的障碍，以加强这一高风险亚组的患者管理。目前的研究表明，痛风和 CKD 患者的患者特征和结局存在重要差异。在研究期间，亚人群、年龄和合并症之间的医疗保健利用率不同，无论年龄大小，患有 CKD 的痛风患者的 5 年死亡率风险更高。未来的工作应该探索与这些结果相关的因素和痛风控制的障碍，以加强这一高风险亚组的患者管理。